Current Opinion in Pharmacological and Non-Pharmacological Treatment of Migraine: A Focus on Calcitonin Gene-Related Peptide

*Corresponding author: Babar Mirza* and Wageha Akel

Abstract

The most common neurologic disorder is migraines. Migraine is defined as throbbing headaches that can be associated with auras. The headaches are episodic and can be debilitating in quality. Migraines can be triggered by emotional stress, lack of sleep, bright lights, loud noise, certain foods, and other environmental factors. The most effective way of preventing migraines is to avoid these triggers. A migraine can begin with prodromes or warning signs such as loss of vision, loss of motor reflexes or sensation. In this review, the types of migraine, signs and symptoms, pathways leading up to auras, and detailed pathophysiology will be discussed. The pathophysiology of a migraine consists of three different mechanisms: 1) cortical spreading depression, 2) the trigemino vascular system, and 3) sensitization. Three different treatment methods for a migraine will be discussed: 1) pharmacological, 2) non-pharmacological and 3) lifestyle modifications. Lifestyle modifications include eating a healthy diet, exercising, and maintaining proper sleep hygiene. Pharmacological treatments can be preventative or abortive. The latest migraine treatment of calcitonin gene-related peptide (CGRP) antagonist use will be discussed in this review and compared to other treatments such as nonsteroidal anti-inflammatory drugs (NSAIDs), anticonvulsants, and Triptans. Future research methods to prevent and better treat migraine headaches are considered a hot topic in medicine and these novel methods will be discussed.
Keywords
Migraine treatment; CGRP antagonists; Neuromodulation; Nerve stimulation; Trigeminal activation; Cortical spreading depression.